Clinical data are largely focused on depressive comorbidity in OCD. However in practice, treating resistant or severe OCD sufferers revealed many cases who seem to have an authentic OCD with a hidden comorbid bipolar disorder. Most reports had evaluated the OCD comorbidity in unipolar and bipolar mood disorders (Kruger et al., 1995; Chen et Dilsaver, 1995). The only investigation in clinical population focused on the reverse issue was conducted in Pisa. Perugi et al. (1997) have showed in a consecutive series of 315 OCD outpatients, that 15.7% presented a bipolar comorbidity, mostly with BP-II disorder. Further analyses suggested that when comorbidity occurs with bipolar and unipolar depression, it has a differential impact on the clinical picture and course of OCD. The rate of bipolar comorbidity in OCD was analyzed in a recent epidemiological survey undertaken by the French Association of patients suffering from OCD (FA-OCD or AFTOC in French). In a sample of 453 OCD patients, 76% had suffered from a major depression, 11% from bipolar disorder (DSM IV mania or hypomania), 30% from hypomania (cases that obtained a score > or = 10 on the self-rated Angst Hypomania Checklist). According to the score > or = 10 on Self-rated Questionnaire for Cyclothymic Temperament, 50% were classified as cyclothymic. The self-assessment of soft-bipolar dimensions, such as hypomania and cyclothymia was previously validated in a multi-site study in major depression (Hantouche et al., 1998). Further analyses showed that comorbidity with soft bipolarity was characterized by significant interactions with high levels of impulsivity, anger attacks and suicidal behavior. In order to confirm these data, another cohort (n = 175 patients treated by psychiatrists for OCD) was formed and named "PSY-OCD". Comparative analyses between the two populations allowed showing very few demographic and clinical differences. The frequency rate of "bipolar OCD" was equivalent in both populations: BP-II disorder (DSM IV criteria) was present in 11% of FA-OCD and 16% of PSY-OCD. Furthermore using the Hypomania Checklist showed that BP-II disorder rate (score > or = 10) was higher: 32% of in both populations. Cyclothymic rate was also globally higher, but significant difference was obtained: 56% of FA-OCD versus 45% of PSY-OCD (p = 0.02). Moreover, mood switching rate under anti-OCD drugs was equivalent in both OCD populations (respectively 38% and 33%, p = ns). In case of BP comorbidity, patients had presented a greater number of concurrent major depressive episodes and suicidal attempts. When concurrent depression was considered, the rate diagnosis of soft bipolarity was 2.5 fold, and the number of suicidal attempts augmented by 7 fold (by comparison versus non-depressed OCD). Despite very early descriptions (since the beginning of the last century) of particular relationships between so-called "psychasthenia, folie de doute, folie raisonnante" and "circular and intermittent madness or cyclothymia", a few attention has been devoted to this complex pattern of comorbidity. The comparative data deriving from the collaborative survey with patients who are members of AFTOC and with a cohort of psychiatric outpatients, confirm the reality of bipolar-OCD comorbidity, which is largely under-recognized in clinical practice. More in depth analyses are now undertaken in order to investigate the characteristics of "bipolar OCD" by comparison to "non bipolar OCD".
"A similar pattern was observed for bipolar disorder and obsessive-compulsive disorder, two diseases not only known to be genetically linked but also known to occur together commonly in patients [16,17]. We found that this disease pair had a genetic overlap of 53.48% consisting of 307 genes, however the only cross-disease citations were for BDNF  and SLC6A4 , genes that are widely implicated in over 300 other disorders and potentially less directly related to the mechanistic causes of disease than other genes. "
[Show abstract][Hide abstract] ABSTRACT: Background
Technological leaps in genome sequencing have resulted in a surge in discovery of human disease genes. These discoveries have led to increased clarity on the molecular pathology of disease and have also demonstrated considerable overlap in the genetic roots of human diseases. In light of this large genetic overlap, we tested whether cross-disease research approaches lead to faster, more impactful discoveries.
We leveraged several gene-disease association databases to calculate a Mutual Citation Score (MCS) for 10,853 pairs of genetically related diseases to measure the frequency of cross-citation between research fields. To assess the importance of cooperative research, we computed an Individual Disease Cooperation Score (ICS) and the average publication rate for each disease.
For all disease pairs with one gene in common, we found that the degree of genetic overlap was a poor predictor of cooperation (r2=0.3198) and that the vast majority of disease pairs (89.56%) never cited previous discoveries of the same gene in a different disease, irrespective of the level of genetic similarity between the diseases. A fraction (0.25%) of the pairs demonstrated cross-citation in greater than 5% of their published genetic discoveries and 0.037% cross-referenced discoveries more than 10% of the time. We found strong positive correlations between ICS and publication rate (r2=0.7931), and an even stronger correlation between the publication rate and the number of cross-referenced diseases (r2=0.8585). These results suggested that cross-disease research may have the potential to yield novel discoveries at a faster pace than singular disease research.
Our findings suggest that the frequency of cross-disease study is low despite the high level of genetic similarity among many human diseases, and that collaborative methods may accelerate and increase the impact of new genetic discoveries. Until we have a better understanding of the taxonomy of human diseases, cross-disease research approaches should become the rule rather than the exception.
BMC Medical Genetics 11/2012; 13(1):114. DOI:10.1186/1471-2350-13-114 · 2.08 Impact Factor
"La presenza di una più precoce età di esordio dei sintomi ossessivo-compulsivi nei pazienti con associato disturbo bipolare, riportata da alcuni lavori  , non trova invece una piena convalida nei nostri dati: l'esordio è infatti tendenzialmente più precoce (15 vs 19 anni), ma la differenza non raggiunge la significatività statistica . Allo stesso modo non abbiamo trovato dati a conferma di una più alta prevalenza di decorso episodico, contrariamente a quanto rilevato in precedenza da altri autori  . Tuttavia, merita una menzione la tendenza del DOC in circa il 40% dei casi a esordire prima della sintomatologia affettiva , il che conferma la necessità di porre l'attenzione sugli eventuali predittori di bipolarità al fine di indirizzare adeguatamente i trattamenti. "
[Show abstract][Hide abstract] ABSTRACT: IntroductionThe onset of bipolar symptoms in patients with obsessive-compulsive disorders (OCD) is a common problem with important prognostic and therapeutic implications. Rates of comorbidity between the two disorders run as high as 30%. The aim of the present study was to explore socio-demographic and clinical differences between OCD patients with and without bipolar disorders to identify predictive factors that can guide treatment choices.
Quaderni Italiani di Psychiatria 09/2011; 30(2):75-82. DOI:10.1016/j.quip.2011.04.002
"A problematic topic is the treatment of obsessive-compulsive symptoms that are frequent both in patients with AS  and BD [32,33]. In the case of AS-BD comorbidity, it may be difficult to attribute obsessive-compulsive symptoms to one of the two syndromes. "
[Show abstract][Hide abstract] ABSTRACT: Asperger's Syndrome (AS) is a pervasive developmental disorder that is sometimes unrecognized, especially in the adult psychiatric setting. On the other hand, in patients with an AS diagnosis, comorbid psychiatric disorders may be unrecognized in the juvenile setting. The aim of the paper is to show and discuss some troublesome and complex problems of the management of patients with AS and comorbid Bipolar Disorder (BD).
The paper describes three patients affected by AS and bipolar spectrum disorders.
Mood stabilizers and 2nd generation antipsychotics were effective in the treatment of these AS patients with comorbid BD, while the use of antidepressants was associated with worsening of the mood disorder.It is of importance to recognize both the psychiatric diagnoses in order to arrange an exhaustive therapeutic program and to define specific and realistic goals of treatment.
Clinical Practice and Epidemiology in Mental Health 12/2008; 4(1):26. DOI:10.1186/1745-0179-4-26
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